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July 17, 2003 Vol. 349 No. 3
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This randomized trial tested the idea that finasteride, which inhibits the production of androgens within the prostate, can prevent prostate cancer. The participants were to receive finasteride or a placebo daily for seven years. Prostate cancer was found in 18.4 percent of the men in the finasteride group and in 24.4 percent of those in the placebo group. Higher-grade cancers (Gleason score, 7, 8, 9, or 10) were more common in the finasteride group than in the placebo group. Sexual dysfunction was more common in the finasteride group, and urinary difficulties were more common in the placebo group.
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Patients with asthma are commonly sensitized to house-dust-mite allergen; the microscopic creatures that produce this allergen live in bedding. The use of dust-mite–impermeable covers for bedding has been advocated as a way to prevent exacerbations of asthma. In this study involving more than 1100 adult patients with mild asthma, the use of allergen-impermeable bedding had no effect on airflow rates as compared with the use of bed covers that were not impermeable to allergen.
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Patients with allergic rhinitis are often instructed to avoid allergens as a way of preventing symptoms. This study examined a common intervention used to avoid allergens — encasing pillows, mattresses, and duvets in house-dust-mite–proof covers — as a specific part of an allergen-avoidance program. The use of these coverings had no effect on the symptoms of rhinitis.
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In some colorectal cancers, a loss of DNA-repair function causes a defect called microsatellite instability. This study unexpectedly found that adjuvant treatment with fluorouracil did not benefit patients whose tumors had high-frequency microsatellite instability, whereas such treatment did benefit patients with microsatellite-stable tumors.
A 28-year-old woman telephones her physician to report dysuria and urinary urgency during the preceding three days. She has had several previous urinary tract infections, including three during the past year. She is otherwise healthy, takes no medications, and is sexually active, using spermicide-coated condoms for contraception. She does not have fever, chills, vaginal discharge, or flank pain. How should she be evaluated and treated?
Embryonic stem cells have been the focus of intense study over the past two decades. Embryonic stem cells originate from undetermined early embryos, with no possible history of differentiation, whereas the provenance of adult stem cells found in mature tissues is far less well understood. The possibility that a population of reserve stem cells, perhaps set aside during gestation, might be coerced into renewed regenerative service later in life holds great promise. This review considers the status of stem-cell research.
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